Organization Active NPI

San Antonio Spine Surgery Center PLLC

  • Orthopaedic Surgery of the Spine Physician
  • Live Oak, TX
National Provider Identifier
1205082104
Registry record updated Oct 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X
License
M9701 Issued in TX
Legal business name
SAN ANTONIO SPINE SURGERY CENTER PLLC
Practice address
12501 Judson Rd
Ste 201
Live Oak, TX 78233-4103
Phone
(210) 615-8292
Fax
(210) 615-8297
NPI assigned
Aug 11, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Yvonne Lopez
Title
Credentialing Coordinator
Phone
(210) 615-8292

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery of the Spine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207XS0117X M9701 TX Primary

Addresses

Primary practice location

12501 Judson Rd
Ste 201
Live Oak, TX 78233-4103

Mailing address

8255 Fredericksburg Rd
San Antonio, TX 78229-3357
Phone (210) 615-8292

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/10136/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1218412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223856000000",
    "number": "1205082104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8255 FREDERICKSBURG RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293357",
            "telephone_number": "210-615-8292",
            "fax_number": "210-615-8297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12501 JUDSON RD",
            "address_2": "STE 201",
            "city": "LIVE OAK",
            "state": "TX",
            "postal_code": "782334103",
            "telephone_number": "210-615-8292",
            "fax_number": "210-615-8297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN ANTONIO SPINE SURGERY CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-11",
        "last_updated": "2008-10-13",
        "status": "A",
        "authorized_official_last_name": "LOPEZ",
        "authorized_official_first_name": "YVONNE",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "210-615-8292"
    },
    "taxonomies": [
        {
            "code": "207XS0117X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "TX",
            "license": "M9701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Live Oak, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.